Underuse of long-term routine hospital follow-up care in patients with a history of breast cancer?

Background: After primary treatment for breast cancer, patients are recommended to use hospital follow-up care routinely. Long-term data on the utilization of this follow-up care are relatively rare. Methods: Information regarding the utilization of routine hospital follow-up care was retrieved from hospital documents of 662 patients treated for breast cancer. Utilization of hospital follow-up care was defined as the use of follow-up care according to the guidelines in that period of time. Determinants of hospital follow up care were evaluated with multivariate analysis by generalized estimating equations (GEE). Results: The median follow-up time was 9.0 (0.3-18.1) years. At fifth and tenth year after diagnosis, 16.1% and 33.5% of the patients had less follow-up visits than recommended in the national guideline, and 33.1% and 40.4% had less frequent mammography than recommended. Less frequent mammography was found in older patients (age > 70; OR: 2.10; 95%CI: 1.62-2.74), patients with comorbidity (OR: 1.26; 95%CI: 1.05-1.52) and patients using hormonal therapy (OR: 1.51; 95%CI: 1.01-2.25). Conclusions: Most patients with a history of breast cancer use hospital follow-up care according to the guidelines. In older patients, patients with comorbidity and patients receiving hormonal therapy yearly mammography is performed much less than recommended

Correlation between imaging and pathology in ductal carcinoma in situ of the breast

BACKGROUND: It is helpful in planning treatment for patients with ductal carcinoma in situ (DCIS) if the size and grade could be reliably predicted from the mammography. The aims of this study were to determine if the type of calcification can be best used to predict histopathological grade from the mammograms, to examine the association of mammographic appearance of DCIS with grade and to assess the correlation between mammographic size and pathological size. METHODS: Mammographic films and pathological slides of 115 patients treated for DCIS between 1986 and 2000 were reviewed and reclassified by a single radiologist and a single pathologist respectively. Prediction models for the European Pathologist Working Group (EPWG) and Van Nuys classifications were generated by ordinal regression. The association between mammographic appearance and grade was tested with the χ(2)-test. Relation of mammographic size with pathological size was established using linear regression. The relation was expressed by the correlation coefficient (r). RESULTS: The EPWG classification was correctly predicted in 68%, and the Van Nuys classification in 70% if DCIS was presented as microcalcifications. High grade was associated with presence of linear calcifications (p < 0.001). Association between mammograhic- and pathological size was better for DCIS presented as microcalcifications (r = 0.89, p < 0.001) than for DCIS presented as a density (r = 0.77, p < 0.001). CONCLUSIONS: Prediction of histopathological grade of DCIS presenting as microcalcifications is comparable using the Van Nuys and EPWG classification. There is no strict association of mammographic appearance with histopathological grade. There is a better linear relation between mammographic- and pathological size of DCIS presented as microcalcifications than as a density, although both relations are statistically significant

Hyperthermic Isolated Limb Perfusion with TNF α and Cisplatin in the Treatment of Osteosarcoma of the Extremities: A Feasibility Study in Healthy Dogs

Purpose. The feasibility of hyperthermic isolated limb perfusion (HILP) with tumor necrosis factor-α (TNFα ) and cisplatin for the management of osteosarcoma was studied in the canine model

N-band Observations of He 2-10: Unveiling the Dusty Engine of a Starburst Galaxy

To better understand the early stages of massive star cluster evolution we have obtained J,H,K', and N (10.8 micron) images of the nuclear region of the starburst galaxy He 2-10. The N-band images were obtained with the Gemini North telescope and reveal four of the five enshrouded clusters, or "ultradense HII regions" (UDHIIs), recently discovered in radio maps. None of these sources appears in either the optical HST images or the near-infrared images. They comprise about 60% of the total N-band flux from He 2-10 and, we suspect, a similar fraction of the total far infrared flux measured by IRAS. The inferred spectra of the UDHIIs are very similar to those of Galactic ultracompact HII regions and we have modeled the UDHIIs under the assumption that they are "scaled-up" versions of these objects. The bolometric luminosity of the brightest UDHII is estimated to be ~2x10^9 L_sun, and the total mass of the dust and gas is ~10^7 M_sun. The mass of the enshrouded stellar cluster must be > 2.5x10^6 M_sun and the age must be < 4.8x10^6 yr. All of the stellar clusters within the UDHIIs must have ages less than about 5x10^6 yr and masses greater than about 5x10^5 M_sun. The logarithmic ratios of the radio to far infrared flux densities for the individual UDHIIs, and He 2-10 as a whole, are significantly larger than the average for normal galaxies, but comparable to those for ultraluminous infrared galaxies. Large ratios for some starburst galaxies may indicate that a significant fraction of the far infrared flux arises from UDHIIs. If all of the far infrared flux from He 2-10 and other starbursts is produced by heavily obscured regions, the observed correlation between UV continuum slope and infrared-to-ultraviolet flux ratio in starbursts cannot be due primarily to UV reprocessing by dust in a foreground screen.Comment: 41 pages, 9 figure

Tune in to your emotions: a robust personalized affective music player

The emotional power of music is exploited in a personalized affective music player (AMP) that selects music for mood enhancement. A biosignal approach is used to measure listeners’ personal emotional reactions to their own music as input for affective user models. Regression and kernel density estimation are applied to model the physiological changes the music elicits. Using these models, personalized music selections based on an affective goal state can be made. The AMP was validated in real-world trials over the course of several weeks. Results show that our models can cope with noisy situations and handle large inter-individual differences in the music domain. The AMP augments music listening where its techniques enable automated affect guidance. Our approach provides valuable insights for affective computing and user modeling, for which the AMP is a suitable carrier application

The role of biophysical cohesion on subaqueous bed form size

Biologically active, fine-grained sediment forms abundant sedimentary deposits on Earth's surface, and mixed mud-sand dominates many coasts, deltas, and estuaries. Our predictions of sediment transport and bed roughness in these environments presently rely on empirically based bed form predictors that are based exclusively on biologically inactive cohesionless silt, sand, and gravel. This approach underpins many paleoenvironmental reconstructions of sedimentary successions, which rely on analysis of cross-stratification and bounding surfaces produced by migrating bed forms. Here we present controlled laboratory experiments that identify and quantify the influence of physical and biological cohesion on equilibrium bed form morphology. The results show the profound influence of biological cohesion on bed form size and identify how cohesive bonding mechanisms in different sediment mixtures govern the relationships. The findings highlight that existing bed form predictors require reformulation for combined biophysical cohesive effects in order to improve morphodynamic model predictions and to enhance the interpretations of these environments in the geological record

Brief cognitive behavioral therapy compared to general practitioners care for depression in primary care: a randomized trial

<p>Abstract</p> <p>Background</p> <p>Depressive disorders are highly prevalent in primary care (PC) and are associated with considerable functional impairment and increased health care use. Research has shown that many patients prefer psychological treatments to pharmacotherapy, however, it remains unclear which treatment is most optimal for depressive patients in primary care.</p> <p>Methods/Design</p> <p>A randomized, multi-centre trial involving two intervention groups: one receiving brief cognitive behavioral therapy and the other receiving general practitioner care. General practitioners from 109 General Practices in Nijmegen and Amsterdam (The Netherlands) will be asked to include patients aged between 18-70 years presenting with depressive symptomatology, who do not receive an active treatment for their depressive complaints. Patients will be telephonically assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to ascertain study eligibility. Eligible patients will be randomized to one of two treatment conditions: either 8 sessions of cognitive behavioral therapy by a first line psychologist or general practitioner's care according to The Dutch College of General Practitioners Practice Guideline (NHG- standaard). Baseline and follow-up assessments are scheduled at 0, 6, 12 and 52 weeks following the start of the intervention. Primary outcome will be measured with the Hamilton Depression Rating Scale-17 (HDRS-17) and the Patient Health Questionnaire-9 (PHQ-9). Outcomes will be analyzed on an intention to treat basis.</p> <p>Trial Registration</p> <p>ISRCTN65811640</p